Project Summary/Abstract Up to 65% of adults aged 65 and over will lose their ability to independently ambulate during hospitalization primarily because they were not engaged in walking during their stay. Loss of independent ambulation is now identified as a hospital acquired disability and a significant patient safety concern. Older adults spend greater than 80% of the time in bed during hospitalization and only engage in ambulation 4% of the time. Costs for new onset disability in the United States are estimated to be 26 billion dollars annually to cover increased medical and long term care needs. Having a recent hospitalization and restricted activity were strongly associated with development of a new functional impairment in older persons. Although patient ambulation may fall within the domain of multiple healthcare providers (nurses, physical and occupational therapy, and physicians), nurses have traditionally been responsible for promoting and maintaining patients? functional mobility. But nurses infrequently ambulate patients due to multiple personal and organizational barriers that prevent them from getting patients up to walk. Asking nurses to do more will not fix the harm that is being caused to hospitalized older adults or mounting costs due to increased need for health care resources post discharge. Innovative models of care are needed that address and overcome barriers that prevent nurses from walking older patients. Pilot study results of our model of care, Mobilizing Older adults Via a systems-based INtervention (MOVIN) have demonstrated statistically significant increases in patient ambulation and change in nursing practice and unit culture, which have been sustained on the study unit for over 3 years. Our next step is to conduct an RCT using an incomplete stepped wedge cluster randomization design across four adult medical inpatient units in two hospitals. The overarching hypothesis of this project is that MOVIN will improve functional outcomes for older adult patients by producing a change in nursing practice and culture of ambulation on inpatient units. Specific aims are to: 1) test the effectiveness of MOVIN to improve functional ability of older adult patients at discharge, and 1, 3, and 6 months post discharge; 2) test the effectiveness of MOVIN to reduce healthcare utilization of older adults at discharge, and 1, 3, and 6 months post discharge; 2a) analyze a return on investment of MOVIN based on program costs and health utilization measures across different hospitals; and 3) measure change in nurse behaviors and unit culture and identify ongoing systems barriers that impact translation of MOVIN across inpatient units and different hospitals. We propose to accomplish these aims with the overarching goal of eliminating loss of independent ambulation in hospitalized older adults. This proposed project has the potential to prevent development of physical disability (loss of independent ambulation) and functional decline, improve overall quality of life for older adults during and after their hospital stay, and decrease healthcare utilization. The proposed project has the capacity to be immediately translated to other hospitals to improve care quality to older adults across the United States.